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Exercise is forEvery Body

by Tom Spring, M.S., ACSM HFS/CES, FAACVPR

Health, wellness and fitness become a centralfocus when our communities and families facehealth challenges. The good news is that manychronic conditions can be positively affectedby lifestyle choices, including exercise. If youare already very fit and active, or if you are juststarting to think about exercise and physicalactivity, having a plan of action to promotegood health is very important.

Why is regular exercise key to our health? Thehuman body is made to move. There aredocumented exercise-related benefits topractically every system in the body. Thebenefits to the cardiovascular system, muscleand bone may receive the most attention, but

other systems also respond favorably toexercise. For example, the immune system of atrained person works better to fight bothchronic and acute disease than the immunesystem of a sedentary person. Regardless ofyour age, sex, health status, genetics or race,being more physically active (as appropriatefor you) will have a positive impact on yourphysiology, how your body works internally.This article will help you outline some keysteps to better health and fitness.

Define Your Unique Goals,Program

First, you must have a goal. Many peopledecide to exercise after they learn that it mighthelp them treat a health issue, such as obesityor diabetes. Some become fit to prevent achronic disease deeply rooted in their familyhistory. Others are active already, and theystrive to achieve higher levels of performanceat a given sport or activity. Whatever yourmotivation for starting or continuing anexercise program, having at least one clear,achievable goal is important. If you do nothave a goal, your exercise will lack directionand purpose, and it will be difficult to sustainlong-term. Many people have started anexercise program only to stop or “fall off thewagon” a few weeks later. Having a clear goalin mind will help provide the motivation tocontinue to exercise. Regardless of why youchoose to exercise, building regular exerciseinto your daily routine is the most importantingredient to your success.

Next, evaluate where you are from a healthstandpoint. If you are under age 45 with nomajor health issues, and you are relatively fit,starting or adding to your exercise programshould be safe for you. If you are older andstill healthy (no cardiovascular disease,diabetes, cancer, etc.), but you have notexercised much recently, start with a walkingprogram and some light resistance training toget your body primed for exercise. If you havechronic health issues, your first step should beto consult with your physician or health care

Supported by

A m e r i c A n c o l l e g e o f S p o r t S m e d i c i n e

AcSm Fit Society® pAge

Letter from the Editorby Dixie L. Thompson, Ph.D., FACSM

Welcome to the Fall 2011 edition of theACSM Fit Society Page, sponsored byLiberty Mutual. The rising prevalence ofchronic diseases makes it difficult forexercise professionals to prescribe a one-size-fits-all physical activity program. What’s rightfor one person may not be right for another.Thus, the fall issue is focused on exerciseafter injury or when faced with a chroniccondition. While physical activity canprovide a multitude of benefits, there is nosimple plan that works for everybody. In thisissue, we’ll share the basics of developingspecialized exercise programs and how theExercise is Medicine ® initiative is changingthe way health care providers look atprevention. We’ll also discuss some of thespecific issues surrounding exercise forchildren with concussions, older adults withco-morbidities and people with spinal cordinjuries.

Please look over this information that ACSMexperts have prepared for you and share itwith friends and family. We hope thesearticles will help you understand yourunique needs and identify the exerciseprogram that’s right for you!

Dixie L. Thompson, Ph.D., FACSM

Editor, ACSM Fit Society® Page

E-mail: dixielee@utk.edu

To subscribe to the ACSM Fit Society® Page,please send an email to publicinfo@acsm.org.

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Fall 2011

I N S I D E T H I S I S S U E :1 | Letter from the Editor1 | Exercise is for Every Body2 | Q&A with ACSM3 | Helping Young Athletes Cope with Concussion

4 | Managing Co-Morbidities for the Older Adult5 | After A Spinal Cord Injury: Regaining Independence

Through Exercise7 | Exercise is Medicine®: A Focus on Prevention7 | The Athlete’s Kitchen

ACSM Fit Society® Page Editorial Board:Dixie L. Thompson, Ph.D., FACSM, Editor

University of TennesseeThomas S. Altena, Ed.D.

Southwest Missouri State UniversityKatherine A. Beals, Ph.D., R.D., FACSM

University of UtahGreg Chertok, M.Ed.

The Physical Medicine and Rehabilitation CenterDawn Coe, Ph.D.

University of TennesseeKate A. Heelan, Ph.D., FACSM

University of Nebraska-KearneyCherilyn Hultquist, Ph.D.

Kennesaw State UniversityGerald Jerome, Ph.D.

Towson UniversityAnthony C. Luke, M.D., M.P.H., FACSM

University of California, San FranciscoLynn Millar, Ph.D., FACSM

Winston-Salem State University

ACSM is the world’s largest association devoted tosports medicine and exercise science. ACSM advances andintegrates scientific research to provide educational andpractical applications of exercise science and sportsmedicine.

Permission to reprint material from this publication isgranted by ACSM contingent upon manuscripts beingreprinted in total without alteration and on proper creditgiven to ACSM by citing ACSM Fit Society® Page, issue andpage number; e.g., “Reprinted with permission of theAmerican College of Sports Medicine, ACSM Fit Society®

Page, Fall 2011, p. 3.”

provider for some direction on starting anexercise program.

Finally, your exercise program should bedesigned to help you meet your goals. Thissounds complicated, but it does not need tobe. For those just starting out with a goal ofbetter health or lower blood pressure andcholesterol, your program should includesome simple components. You could chooseany moderate-intensity aerobic activity(walking, bicycling or swimming) that issustained for more than ten minutes. Theseactivities increase your energy expenditureabove resting and are consideredcardiovascular in nature. These types ofexercises will cause an increase in your heartrate and breathing, but you should be able tocarry on a conversation while performingthese exercises. Exercises that stress individualmuscles or movements using weight of anykind (i.e. dumbbells, body weight and bands)

for a short duration would be consideredresistance training. At a minimum, yourweekly routine should incorporate two days ofresistance exercise and multiple days ofaerobic exercise. If you have not beenexercising previously, start with 10-20 minutesof walking, biking, rollerblading or othercardiovascular exercise, and add a minute ortwo to your time each week. Shoot for threesessions each week, and add a day after threeor four weeks to increase your exercisevolume. Combining resistance andcardiovascular exercises is crucial for youroverall fitness.

If you are already active, consider addingintensity and new exercise techniques, orconsult with a trained professional for moredirection and ideas. Training for a specificevent often helps revamp your program with agoal (i.e. marathon or triathlon) that allowsyou to set up a program with a timeline and

process. This is called periodization training,and it will enhance your exercise program andmay provide a real boost to your motivation.

Listen to Your BodyAnyone with a chronic condition, such ascardiovascular disease, diabetes or arthritis,should first consult his/her physician prior tobeginning an exercise program. Once you are

Q&Aby Anthony Luke, M.D., FACSM

Q: I have been very obese for a long time, and I’ve decided to undergo weight reductionsurgery. I’d like to exercise again, as I haven’t been physically active for a long time. Will Ibe able to exercise after the surgery?

A: Surgery for weight loss is a commonly discussed procedure for patients with extremely highweight. Surgery may be recommended for patients with severe obesity (BMI above 40) who have notresponded to diet, exercise or weight loss medications, or for patients with a BMI between 35 and40 who have a serious medical condition (including diabetes, severe joint pain or sleep apnea) thatwould subside with weight loss. Lap band procedures reduce the amount of food that you can eat atone time by surgically placing a band around the opening of the stomach. Gastric bypass surgery is amore intensive procedure where the stomach is made smaller and attached to the small intestine.Gastric bypass surgery helps you lose weight by reducing the amount of food you can eat (since thestomach is smaller) and reducing the number of calories you absorb (since there is a bypass of partof the intestine).

Both of these surgeries have shown positive results with weight reduction of approximately half theextra weight or more after surgery. A recent study by researchers at the University of Texas showedthat about 50 percent of individuals who performed a high-volume exercise program (≥2,000kcal/week) after the surgery had enhanced physical fitness. All patients reported better quality of life.Therefore, exercise is still a necessary portion of the post-operative plan.

Weighing less should also make it much easier for you to move around and do your everydayactivities. Bypass surgery alone is not a solution for weight loss. It can train you to eat less, but youstill have to do the work to lose weight and keep it off. To avoid complications from the procedure,you must follow the exercise and nutrition guidelines that your doctor and dietitian give you.

Exercise is a key to achieving the body you want after weight loss bariatric surgery. Getting startedon a gradual exercise and physical activity plan is a very important part of bariatric surgery. Anexercise plan should begin before and resume after (as soon as your doctor allows) bariatric surgery.A doctor should closely supervise your exercise or activity plan. Try to get at least 30 minutes ofphysical activity each day above and beyond what you typically do in a day.

Q: My nephew has cystic fibrosis, and his friends are ready for Little League. Is it safe forhim to participate?

A M E R I C A N C O L L E G E O F S P O R T S M E D I C I N E

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HelpingYoungAthletes Cope withConcussion

by Mark Halstead, M.D., FAAP

With fall upon us, and football season in fullswing, concussions in young athletes are onceagain a hot topic. Despite all the attention paidto concussions in football, athletes in other fallsports, such as soccer, volleyball andcheerleading, also are at risk for a concussion.More than 25 states now have laws to educateand protect players by requiring them to readmaterials on the signs and symptoms ofconcussions and mandating that they notreturn to play for a minimum of 24 hoursafter their concussion. These laws also requireathletes to receive medical clearance from ahealth care professional before they can returnto play.

Concussion Signs andSymptoms

The most common symptom that athletesreport after a concussion is a headache. Somewill have their headache right away, but othersmay take several hours or longer to develop.Another important thing to remember is thatnot every single player will get a headache

after their concussion, so it is important toknow the other signs and symptoms.

Other common signs and symptoms includedizziness, sensitivity to bright light andsounds, feeling “foggy,” difficulty rememberingthings that happened before and/or after theinjury, feeling sick to their stomach, being verytired, and confusion. A common myth inconcussion diagnosis is that a player needed tobe knocked out, or lose consciousness, tohave a concussion. In fact, less than tenpercent of athletes with a concussion will beknocked out.

It is important that athletes, coaches andparents be aware of these signs andsymptoms, as there may not be an obviousoutward sign of a concussion. It is alsoimperative that athletes are honest about theirsymptoms and report them immediately.

What to Do If You Suspect aConcussion

If an athlete is suspected to have a concussion,they should be immediately removed from thegame or practice. They should not be allowedto return to activity the day of their injury.Any athlete who has a severe headache, isrepeatedly vomiting, is difficult to arouse, hasseizure activity, or has difficulty moving theirarms or legs may have a more severe headinjury and should be evaluated in theemergency department.

Following a concussion, if symptoms persist,the athlete should refrain from any physicalactivity that increases his/her heart rate.Exertion often aggravates symptoms,especially in the early days following theinjury. The athlete should follow the advice ofthe health care professionals managing theinjury to determine when it is the right time toreturn to physical activity.

A newer concept in dealing with concussionsis called “cognitive rest.” This means that anathlete may need to reduce their mentalactivity to avoid increasing symptoms. Someexamples of cognitive rest may include ashortened school day, reducing workloads inclass, decreasing reading, spending less time infront of a computer or allowing for extra timeto complete tests or assignments. Not everyathlete will need all forms of cognitive rest,but athletes should avoid things that worsentheir symptoms.

For athletes that are of driving age, anotherconsideration is to have that athlete avoiddriving until symptoms of the concussion areresolved. Reaction time is often delayed

following a concussion, so an athlete may beat higher risk for an accident if she/he drives.

When an Athlete Can Returnto Play

In order for an athlete to return to play, he/shemust be free of symptoms of the concussionboth at rest and with exertion. A return-to-activity progression is frequently used andincreases the level of exertion and exposure tocontact situations over a five-day period.Athletes may fill out a symptom checklist ortake a computer test to assess their recovery.Most importantly, the athlete should receiveclearance from a health care professionalbefore returning to play. Ideally that healthcare professional is someone knowledgeable inthe diagnosis and management of aconcussion.

One concern about returning too soon from aconcussion is developing second impactsyndrome. This condition may develop if anathlete suffers a second head injury before theinitial injury has healed. This may lead to asevere brain injury and even death.

With improved efforts in education, new lawsbeing passed and better protective gear,hopefully we will see improved outcomesfrom youth sport concussions. Teammates canhelp by letting coaches know if someonedoesn’t seem right following a head injury.Coaches can help by not pressuring players toreturn before the athlete is ready and byencouraging their players to disclosesymptoms. Finally, athletes can helpthemselves by being honest about anddisclosing their symptoms and not returningto play before being cleared to do so.

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Managing Co-Morbiditiesfor the Older Adult

by A. Lynn Millar, P.T., Ph.D., FACSM

A concern often voiced by older adults inregards to starting or maintaining an exerciseprogram is their safety. As we age, the chancesof having at least one health problem, if notmultiple issues, greatly increases. While thenumber varies, by age 65, the majority ofAmericans has at least one chronic healthproblem, and almost half have more than one.The term for more than one chronic disease is“co-morbidity.” Some of the most common co-morbidities include cardiovascular disease andits risk factors (which include hypertension,obesity and hyperlipidemia), diabetes,peripheral vascular disease and arthritis.Unfortunately, individuals often fail to educatethemselves and act on their health concerns,and many become increasingly sedentary.However, regular physical activity can helpdecrease many of the negative consequencesbrought about by age-related chronic healthconditions.

Exercise reduces multiple disease risk factorsand helps maintain function. Among otherbenefits, regular activity controls body weight,resting heart rate, blood pressure and bloodsugar. Importantly, even low-level activity willproduce some of these benefits. In otherwords, you do not need to participate inintense exercise to see healthy improvements.

While there are numerous fitness-relatedarticles and books devoted to different chronicdiseases, few specifically address what youshould do when you have multiple co-morbidities. Managing co-morbidities,including developing an activity plan to helpimprove your health and function, can beaccomplished many ways. One stepwiseapproach involves getting informed,consulting with your physician, gettingorganized, enlisting support, getting startedand monitoring your response. Becomingmore active may seem overwhelming;however, completing one step at a time canmake the process doable.

1. Get informed. If you have more than onechronic disease, an educated, common-sense approach will allow you to safely andeffectively participate in activity. Learn asmuch as you can about each of yourdiseases from a reliable source. This may bea national organization devoted to assistingindividuals with that disease, such as theAmerican Heart Association. Suchorganizations often have informationalbrochures and other educational materials.ACSM has a series of texts devoted tophysical activity and specific chronicdiseases, such as arthritis, hypertension anddiabetes.

2. Consult. If you have not been very activepreviously, consult with your physicianbefore starting exercise. The doctor can letyou know if there are any contraindicationsor precautions related to each specifichealth problem. If you have not seen adoctor for a while, some tests may benecessary. Make sure that you discuss eachco-morbidity with your physician.Otherwise, your doctor may be focused onwhat he or she considers the primarydisease and overlook a possible interactionwith another health concern.

3. Get organized. Make yourself a list ofeach health problem you have, themedications you take for that problem andthe precautions that the physician hasidentified for each problem. For example, ifyou have hypertension, you first need tomake sure that it is under control. Somemedications will alter your heart rate andblood pressure response to exercise; thus,intensity of exercise will be determined byyour perception, not by your heart rate.Further, find out what techniques areimportant to safely participate in an activity.For example, during resistance training,you need to avoid the Valsalva maneuver(breath holding while exerting force), asthis can cause abnormal changes in blood

pressure. Then add in the precautions orconcerns for the next disease. Let’s say youalso have diabetes and are on insulin. Thetiming of your activity will be important, asyou may need to set the daily activity basedupon when you eat and when you takeyour insulin.

4. Enlist support. Having support fromfamily, friends or outside groups isinvaluable. Find out if there are activitiesaimed at individuals with your specificconditions. Not only will the others in thegroup understand and be supportive ofyour specific needs, but because theinstructors are educated about that disease,they can help you modify the activity.Certified instructors often learn aboutnumerous disease processes and themodifications that need to be made, so theycan help you adjust exercise based on yourco-morbidities, even if the activity isadvertised to one type of condition.

5. Get started. Now that you have coveredthe basics, you are ready to get started. Ifyour support is through an exercise group,then this step is easier, as the starting pointand activity is already identified. If you aregoing to start with a home-based program,keep it simple. Start with one activity, anddo not overdo it. This is why walking isoften used—it does not need much in theway of equipment (good shoes), it isfunctional and you can set the intensity orduration at a very low level to start.

6. Monitor your response. As youcommence increasing your new activityprogram, keep a diary. Record the activityand your response, noting any unusualsymptoms. While we all will haveoccasional pains or symptoms that do notseem normal, recurring or progressingsymptoms may be significant. A diary is asimple way to identify patterns andimproving symptoms. With some diseasesthis is extremely important, as yourphysician may need to adjust yourmedications as your body adapts to thepositive changes that come with regularactivity.

Importantly, do not let the presence of morethan one chronic disease deter you fromincorporating regular activity into your life.Take it one step at a time, and remember thatchange takes time.

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After a SpinalCord Injury:RegainingIndependenceThroughExercise

by Sue Sandwick, P.T., DPT, NCS

In the blink of an eye, life as you know it ischanged forever. A freak accident has youlying motionless in a dark, whizzing MRItube. As you lie on your back looking up, youtry to move anything from your shouldersdown to your toes, but you can’t. In sharpcontrast to your body, your mind is racing.How did this happen? What will I do? Whatabout the concert this Friday? What aboutgraduation this summer? What about myrelationship that has been going well? Whatabout my future? Your thoughts areinterrupted by the neurosurgeon who tells youthat your vertebrae are crushed, and yourspinal cord is severely compressed. You needsurgery immediately to stabilize your spineand to take the pressure off your spinal cord.As you wake after surgery, hope is slowlyreplaced by dread. There is no feeling in yourlegs, and they do not respond to your mentalcommands to move. The realization hits youlike a ton of bricks: you will have to start overand learn to exist inside a completely differentbody.

After experiencing a spinal cord injury (SCI),most individuals live in a hospital-basedrehabilitation unit for four to eight weeks andundergo extensive rehabilitation therapy. Theaims of therapy are to restore functional abilityand to gain the skills necessary to re-enter life.Traditionally, upon discharge from therehabilitation unit, patients are giveninformation about community disabilityservices and are sent home with theexpectation that they will re-enter their livesand become engaged, productive, active andhealthy. In reality, once SCI patients aredischarged, they generally do not becomephysically and socially active, and thispredisposes them to significant health risks.

Studies have clearly demonstrated that peoplewith SCIs are at increased risk of developingcardiovascular disease and diabetes. Physicalinactivity that is related to impaired mobilityvery commonly leads to a sedentary lifestyle.This sedentary state predisposes SCI patientsto a heightened risk for obesity, bodycomposition changes (loss of lean body massand increased fat mass), lower basal metabolicrate, blood lipid abnormalities, glucoseintolerance and increased risk for pressureulcers. In addition, decreased physicalcapacity leads to a loss of independence,which can lead to feelings of social isolation,ineffectiveness, hopelessness and depression.There is a need to address and solvetransitional challenges for SCI patients,providing post-rehabilitation programming formobility, access and ongoing healthmaintenance, as well as preparing individualsfor an active life.

Based out of the University of Utah, TRAILS(Therapeutic Recreations And IndependentLifestyles) is an SCI outreach programdesigned to address this post-rehab need andto prepare individuals with SCIs to engage inactive living through recreational experiences,adaptive sports, exercise and wellnessprograms, as well as comprehensive, SCI-specific education. These programs andresources have served as a continuum of careand a critical extension to hospital-basedrehabilitation. TRAILS offers a variety ofadapted sports and recreation programs,including year-round cross country skiing,handcycling/spinning, swimming andwheelchair tennis, as well as seasonal downhillskiing, kayaking and sail boating. Theseprograms provide individualized adaptiveequipment and assistance as necessary.Specialists in physical fitness, nutrition,massage and yoga are fully trained about SCIsand form a unique, supportive team thatproactively engage SCI patients inindividualized programming.

TRAILS is open to sharing these benefits andwelcomes any individual who has experienceda SCI to participate. Currently, more than 700individuals receive ongoing communicationabout activities and events. Clients, as well astheir friends and family, are guided intoappropriate programming, and the teamassures a safe, appropriately adapted andsuccessful experience. The hope and eventualgoal is that these individuals will not onlyparticipate with TRAILS, but they willultimately become more independently active.

Scientific evidence demonstrates the physicaland psychological benefits of a well-rounded,activity-based wellness program, such as thatof TRAILS. This programming not onlyactivates a sedentary lifestyle but also can havea positive effect on one’s overall risk forcardiovascular disease and chronic conditionsvia individualized strength training,cardiovascular conditioning, nutritionalawareness, weight management and stressmanagement.

“There’s this stigma that comes with SCI thatit’s a death sentence. It isn’t.” says StanClawson, a TRAILS participant who wasparalyzed 16 years ago. “When you leave thehospital, you look at the world through acocktail straw. A comprehensive program likeTRAILS shows people how to transition into alife of mobility and all the possibilities. Then,with each activity, your horizon opens up. Youare looking through a windshield, then aconvertible, and then you’re flying. Wallsbreak down and it pushes you into the growthzone, giving you a positive distraction. Whenyou are kayaking on that lake, and yourwheelchair is sitting there on the dock, youaren’t thinking about the world of disability.”

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Exercise isMedicine®: AFocus onPrevention

by Elizabeth Joy, M.D., MPH, FACSM

According to a recently released study, it’sestimated that half of all adults in the U.S. willbe obese by the year 2030. The healthconsequences related to that number arestaggering. Increasing rates of obesity wouldmean 7.8 million extra cases of diabetes, 6.8million extra cases of coronary heart diseaseand stroke, and 539,000 extra cancer cases by2030. That’s not to mention a $66 billion peryear increase in health care costs by 2030. Theunderlying causes of our obesity epidemic aremany, and our understanding of obesity isexpanding. Yet our success in moving thepopulation dial has been limited. It will takeefforts from each sector in our society to makea meaningful difference in obesity rates.

The Exercise is Medicine (EIM) initiative,spearheaded by ACSM, improves the role thathealth care providers and health care systemsplay in promoting physical activity in patientsand communities. Starting in 2008 under theleadership of former ACSM President RobertSallis, M.D., EIM has been enormouslysuccessful in highlighting the critical rolehealth care providers play in promoting ahealthy lifestyle and physical activity. EIM nowhas a global presence and is working withpartners on several continents to spread aworldwide message about the importance ofphysical activity in promoting health andpreventing disease.

Much of medical care in the U.S. is centeredon the treatment of chronic disease. It’sestimated that lifestyle behaviors, including

tobacco use, poor diet and “motion deficitdisorder,” contribute to upwards of 40 percentof total health care costs. Yet, physicians spendlittle of their time in medical school, residencytraining and advanced fellowship traininglearning how to counsel patients on a healthylifestyle. As a result, little time during a typicalclinical encounter is spent dealing with theunderlying causes of the chronic diseasesplaguing the patient. To win the battle againstobesity, chronic disease, and the associatedmorbidity and premature mortality, health caremust develop, implement and test tools andsystems that support diagnosis and treatmentof unhealthy lifestyle behaviors.

This is where EIM comes in. The vision ofEIM is to make physical activity and exercise astandard part of a global disease preventionand treatment medical paradigm. EIMadvocates for physical activity to beconsidered by all health care providers as avital sign in every patient visit and thatpatients are effectively counseled and referredas to their physical activity and health needs,thus leading to overall improvement in thepublic’s health and long-term reduction inhealth care costs. To achieve these goals, EIM:

1. Creates a broad awareness that exercise is,indeed, medicine.

2. Makes “level of physical activity” a standardvital sign question at each patient visit.

3. Helps physicians and other health careproviders become consistently effective incounseling and referring patients as to theirphysical activity needs.

4. Leads to policy changes in public andprivate sectors that support physical activitycounseling and referrals in clinical settings.

5. Produces an expectation among the publicand patients that their health care providersshould, and will, ask about and prescribeexercise.

6. Appropriately encourages physicians andother health care providers to be physicallyactive themselves.

EIM is working with global partners to createtools and systems that will support health careproviders in their role promoting physicalactivity. Efforts are underway to create asystem that will facilitate patient referral tohealth and fitness professionals forcomprehensive exercise prescription.

Central to the success of EIM is expansion ofthe evidence base for the role of physicalactivity in the prevention of disease and therole of health care providers in increasingphysical activity levels of patients. TheDiabetes Prevention Trial is a compellingexample of how physical activity can preventchronic disease. In this study, 11 percent ofpatients taking a placebo developed diabetes,

nearly 8 percent of those taking metformin (amedication that promotes uptake of glucoseinto cells) became diabetic, but only about 5percent of those who engaged in a 16-weeklifestyle improvement program were diagnosedwith diabetes. A central part of this programwas 150 minutes per week of moderate-intensity physical activity. Overall, the lifestyleintervention reduced the incidence of Type 2diabetes by 58 percent compared to placebo.

Likewise, there is support for the role ofclinicians in increasing physical activity intheir patients. A recent analysis of severalresearch studies revealed that advice andcounseling of patients in everyday clinicalpractice increased physical activity by 12-50percent for at least six months after thecounseling session. Considering thecomplexity of health care, chronic disease andthe competing demands that require clinicianattention in a typical 15-minute office visit,health care systems are developing strategiesto promote healthy lifestyle outside the officevisit. The Keep Minnesota Active Trial enrolledolder adults, age 50-70, from theHealthPartners health care organization inMinnesota. Subjects were randomized to aninteractive physical activity support programor usual care and followed for a two-yearperiod. The trial demonstrated that thetelephone- and mail-based physical activitymaintenance intervention was effective atmaintaining physical activity in both the short-term (six months) and long-term (12 and 24months) relative to usual care. Thus, healthcare providers can make a real difference inthe lifestyle choices of their patients.

Lifestyle behaviors, including poor diet andphysical inactivity, are leading to higher ratesof chronic disease. EIM seeks to increasephysical activity through efforts aimed atchanging the health care environment to onethat supports physical activity promotion.Making physical activity a vital sign in clinicaloffice visits, providing clinicians and patientswith educational materials, and linking themwith health and fitness professionals are just afew of the efforts underway within EIM.ACSM encourages all clinicians and health andfitness professionals to counsel their patientsand clients that exercise is, indeed, medicine.

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THE aTHlETE’s KiTcHEn:

2011NutritionNews fromACSM

by Nancy Clark, M.S., R.D., C.S.S.D., FACSM

ACSM is the world's largest organization ofsports medicine and exercise scienceprofessionals. At ACSM’s Annual Meeting inDenver, May 31-June 4, 2011, more than6,000 exercise scientists, sports dietitians,physicians and other health professionalsgathered to share their research. Here are afew of the nutrition highlights. Morehighlights are available at www.acsm.org.

• Looking for a way to get fit quickly? High-intensity interval training (HIIT) is effective,though it's hard work. Once you are fit, youcan then reduce the exercise intensity to amore enjoyable (sustainable) level. Dr.Martin Gibala of McMaster University inOntario does not believe HIIT is a heartattack waiting to happen, but herecommends untrained people first get aproper medical check-up.

• HIIT can be an effective part of a weightreduction program. Overweight men whodid 20 minutes of HIIT (eight-secondsprints with 12 seconds recovery) threetimes per week for 12 weeks achieved aseven percent drop in body fat. In anotherstudy with untrained, slightly overweightwomen ages 30-45, those who did high-intensity exercise lost more weight and bodyfat than those who did lower-intensitytraining. One benefit of high-intensityexercise is it can suppress the appetite(temporarily) compared to lower-intensityexercise.

• HIIT can create a significant afterburn. Menwho expended roughly 500 calories during47 minutes of vigorous exercise continuedto burn 225 extra calories over the next 18.5hours.

• When athletes lose weight, they lose muscleas well as fat. For example, soldiers duringnine weeks of combat training lost ninepounds (4.2 kg), of which one-third wasmuscle loss and two-thirds was fat loss.They consumed about 15 percent fewercalories than required to maintain weight.

• Even bodybuilders and figure competitorsdo not lose just body fat when they “leanout.” In the 12 weeks pre-competition, malebodybuilders lost about four lbs (1.8 kg)lean body mass and 11.5 lbs (5.2 kg) bodyfat. The female figure competitors lost about5.5 lbs (2.6 kg) lean and about 6.4 lbs (2.9kg) fat.

• Why do women struggle harder than men tolose undesired body fat? Perhaps becausethey are women. In the animal kingdom,female animals generate less body heat afteroverfeeding compared to the males.Research with humans suggests similarenergy conservation. When four men andfour women were overfed ice cream forthree days (150 percent of energy balanceneeds), the men burned off some of theextra calories while the women conservedenergy, making it easier for them to addbody weight.

• Should you believe the calorie estimatesdisplayed on exercise machines? Doubtful.Research shows that some exercise machinesoverestimate energy expenditure,particularly with women. This can lead toconfusion and frustration for those trying toachieve energy balance.

• A novel way to burn a few extra calories isto sit on a stability ball while you are atwork. At a call center (where 90 percent ofthe time is spent sitting), the employees whosat on the stability ball for five hours duringthe workday burned about 260 morecalories per eight-hour shift. Theoretically,that could lead to loss of 26 pounds in ayear! They burned about half a calorie moreper minute sitting on a stability ball thansitting in a chair. The biggest barrier to usingthe stability balls was aggravation of pre-existing back pain.

• Trained cyclists who consumed equalcalories of either a sports drink or bananachunks during a 75-kilometer cycling timetrial performed similarly. The banana,however, offered a beneficial anti-inflammatory response. Natural foodsgenerally offer more benefits thanengineered sports foods.

• Chocolate milk is a popular recovery foodthat contains carbohydrates to refuel

muscles and high-quality protein to buildand repair muscles. Both full-fat and skimchocolate milk offer similar recoverybenefits.

• Beer is a plant-based beverage that offersantioxidant and anti-inflammatoryproperties. Marathoners who drank 1-1.5liters of non-alcoholic beer per day for threeweeks prior to a marathon and two weeksafter the marathon experienced less post-race inflammation and fewer colds. Non-alcoholic beer offers a wise way to enjoy thenatural high of exercise along with positivehealth benefits.

• Have you ever wondered how much eliteendurance athletes consume during anevent? A post-event survey of Ironmantriathletes, marathoners, long-distancecyclists and professional bike racers suggeststhe Ironmen consumed about 70 grams(280 calories) of carbohydrate per hour; thecyclists consumed 53 grams (212 calories)per hour; and the marathoners consumed35 grams (140 calories) per hour. Theendurance athletes who consumed the mostenergy had the best performances.

• How common are intestinal problemsduring endurance events? About 31 percentof the Ironman competitors reported GIserious problems, compared to 14 percent ofthe half-Ironman competitors, four percentof the cyclists, and four percent of themarathoners. Those with a history of GIdistress reported the most symptoms, as wellas those who exercised in higher heat.

• If you are going to be competing in the heat,you might want to pre-cool your body. Oneway to do that is to enjoy an ice slurry.Runners who consumed about 14-ounces ofice slurry before they exercised in the heatwere able to run about one percent fasterduring a ten kilometer (6.2 mile) race.

• Female athletes commonly restrict their foodintake. Among 44 female high school cross-country runners (16 years-old):

—39 percent restricted food, thinking beinglighter would help them perform better.

—42 percent reported missed or absentmenstrual periods in the past year—a signof being under-fueled.

—They were eight times more likely to believemissing multiple periods was a sign theywere in better shape.

These young women need to be educatedabout the medical problems associated withmissed menstrual periods! • To resume menses, amenorrheic womenneed to correct the energy deficit. Thosewho drank a 360-calorie carbohydrate-protein supplement resumed menses, onaverage, in about 2.5 months (±2 months).The longer they had been amenorrheic, thelonger they needed to resume menses.

ACSM Fit Society® Page • A Quarterly Publication of the American College of Sports Medicine • www.acsm.org • Fall 2011 Page 8

Q&A (continued from page 2) Every Body (continued from page 2)

A: Cystic fibrosis (CF) is the most commongenetic disease in North America. It affects agene that regulates choride transport. Anabnormality may effect secretions in the lungs,gastrointestinal tract, endocrine system andreproductive system. Patients lose a lot of saltin their sweat, which is how doctors oftenmake the diagnosis.

Most individuals are diagnosed by age ten, andlung disease often affects individuals in their20s. In order for children with CF to lead safeand normal lives, adults should encouragethem to participate in physical activity, thoughconsultation with a sport medicine physicianor pediatric respirologist is suggested sinceexercise testing may be recommended inindividuals with severe CF. Coughing duringexercise should not necessarily stop activity.Individuals may even participate in enduranceevents such as marathon running. Like formost medical conditions, exercise usually haspositive effects, helping individuals withconditioning, symptoms and confidence. Foryour nephew, I say “play ball!”

cleared to exercise and have your doctor’srecommendations, there are a few things toconsider. First, progress slowly by addingtime, exercises and intensity to your routinewith caution. Be sure your body has time toadjust to the stress exercise is providing. Forexample, if you are diabetic, check your bloodsugar levels regularly to determine how wellthe levels are being controlled. Monitor yourheart rate, and stay within a targeted heart raterange and below your pain threshold. Thesetips can help avoid over-taxing your system.Increasing exercise volume or intensity tooquickly can lead to injury. But when donecorrectly, the health benefits you gain fromexercise far outweigh risk of injury.

If you have any new pain or discomfort duringor after exercise, you may need to rest oradjust your program. If joint pain appearsduring or after exercise, find ways to changeyour program to avoid the pain. Consult yourphysician or an exercise professional fordirection and advice if you experience painwith exercise. Pain is your body’s signal that

something is not right, so it is wise to listen towhat your body is telling you. Although thelikelihood of a heart attack during exercise isvery small, all people should ensure theyknow the signs and symptoms of a heartattack. If these symptoms are present, seekmedical attention immediately.

Importantly, your chosen exercise plan shouldbe personally fun and interesting. If you don’tenjoy the exercise, it will be very difficult tomaintain your routine. Finding a partner orgroup with that has similar goals, fitness levelsor health issues can be an important key tomaintaining your commitment to exercise. Anexercise buddy or support group is a great wayto stay consistent and keep up the exercise ondays you may not feel like it. Developing anexercise plan that fits your goals and needs iskey, and exercise truly can have a positiveeffect on every body if it is done correctly andsafely.